|
WC CRUISERS MEMBERSHIP FORM |
$15 single or couple Dues payable November 1 WC Cruisers, Inc. PO Box 106 Webster City, IA 50595-0106 Name:___________________________________________________________________________________________ Birthdate:_________________Occupation:_____________________________________________________________ Spouses Name:____________________________________________________________________________________ Birthdate:_________________Occupation:______________________________________________________________ Phone #______________Email Address:______________________________________Cell Phone #:_________________ Address_______________________________________________________City_____________________Zip________ Children___________________________________________________________________Anniversary:____________ Classic Cars (year/make/model)_______________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ LIABILITY: In consideration of the acceptance of the right to participate, members, by execution of this application, release and discharge the WC Cruisers, Inc. their officers, directors, employees, agents, representatives, and anyone else connected with the management or conduct of the WC Cruisers events of and from any and all know and unknown damages, injuries, loses, judgments/and or claims from any causes whatsoever that may be suffered by any member to his person or property. Further, each member expressly agrees to indemnity all of the foregoing entities, firms, persons and bodies of and from any and all liability occasioned or resulting from the conduct of entrants or any participant assisting or cooperating with entrant and under the direction or control of entrant. Signature_____________________________________________________________________ Date________________ Parent or Guardian if under 18 years old ______________________________________________Date_________________ |